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CMS plans to cover continuous glucose monitoring

New doors for treatment and monitoring were opened when the U.S. Centers for Medicare & Medicaid Services (CMS) approved coverage of CGMs for people living with diabetes. People covered by the CMS programs who have either Type 1 or Type 2 diabetes and intensively manage their insulin will now be able to obtain reimbursement.

CGM, or Continuous Glucose Monitoring, is considered the most significant breakthrough in diabetes management in the past 40 years. The traditional standard-of-care for glucose (blood sugar) monitoring has been a finger stick meter. CGM augments the use of glucose meters for the management of diabetes.

Meters and finger sticks are still required to calibrate CGMs and for guidance in making therapy and meal decisions. CGM is important because, in addition to providing the glucose level, it provides the direction and rate of glucose change with the push of a button and alerts users when glucose is too low or too high.

When moving to CGM use, patients will reduce finger stick testing to twice a day instead of four times a day. Testing strips and CGM sensors will be ordered and delivered together, but the daily allowance of strips will be limited to just two a day.

"This is a new era and a huge win for people with diabetes on Medicare who can benefit from therapeutic CGM," said Kevin Sayer, President and Chief Executive Officer, Dexcom, an industry leader in CGM advancements. "This decision supports the emerging consensus that CGM is the standard of care for any patient on intensive insulin therapy, regardless of age."

Therapeutic CGM may be covered by the CMS programs when all of the following conditions exist:

The CGM beneficiary has diabetes mellitus

The beneficiary has been using a home blood sugar monitor and performing frequent (four or more times a day) testing

The beneficiary is insulin-treated with multiple daily injections of insulin or an insulin pump

The patient's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.

In order to be covered, the system must be defined as a “therapeutic” CGM, meaning you can make treatment decisions using the device. The only CGM system that falls within this classification is Dexcom’s G5 CGM System, which received FDA approval for insulin dosing in early 2017.

CGM devices give glucose readings continuously through the day. This helps people with diabetes track their blood sugar levels in more effectively. Blood sugar monitors use finger sticks for each reading, but CGM can provide up to 288 glucose readings a day.

Most CGM users have type 1 diabetes, but more patients with type 2 diabetes who are insulin-dependent are now using CGM. Diabetes Management & Supplies is a certified distributor of Continuous Glucose Monitoring devices and a provider of diabetes education and insulin pump training.

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